Department of Ophthalmic Plastic and Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India.
Department of Oculoplasty and Ocular Oncology, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
Indian J Ophthalmol. 2024 Oct 1;72(10):1466-1470. doi: 10.4103/IJO.IJO_2593_23. Epub 2024 Apr 16.
Assessment of central and peripheral contrast sensitivity (CS) in thyroid eye disease (TED) with and without dysthyroid optic neuropathy (DON).
This cross-sectional study enrolled 33 eyes of 18 treatment-naïve TED patients and 18 age- and sex-matched healthy controls for comparative analysis. A detailed ophthalmic examination included visual acuity (VA), intraocular pressure measurement, slit-lamp biomicroscopy, and CS testing (central and four peripheral regions) using Spaeth-Richman Contrast Sensitivity test was done.
The average age of TED patients was 47.17 ± 13.99 years and a female preponderance was noted (66.66%, n = 12). Twenty-five eyes (75.8%) were diagnosed as TED without DON, while eight eyes (24.2%) had DON. Nine eyes (27.2%) were in the active stage of disease and 29 eyes (87.8%) had proptosis. The difference in mean logMAR visual acuities between TED patients and controls was statistically insignificant ( P = 0.189), but a significant difference was noted in central and total CS score ( P < 0.001, Wilcoxon-Mann-Whitney test). On CS comparison between DON and non-DON eyes, a significant difference in average scores was noted in central and all peripheral areas ( P < 0.05, Wilcoxon-Mann-Whitney test). With increasing clinical activity score, a statistically significant reduction was noted in CS in three out of four peripheral regions (Spearman correlation, P < 0.05).
Visual function compromise can be detected in TED in the presence of intact VA, by testing CS. Peripheral CS deteriorates with increasing inflammation and in DON. Serial monitoring of both central and peripheral CS may help in diagnosing DON early.
评估甲状腺眼病（TED）伴或不伴甲状腺机能亢进性视神经病变（DON）患者的中央和周边对比敏感度（CS）。
本横断面研究纳入了 18 例未经治疗的 TED 患者的 33 只眼和 18 例年龄和性别匹配的健康对照者进行比较分析。详细的眼科检查包括视力（VA）、眼压测量、裂隙灯生物显微镜检查和使用 Spaeth-Richman 对比敏感度测试进行 CS 测试（中央和四个周边区域）。
TED 患者的平均年龄为 47.17 ± 13.99 岁，女性占优势（66.66%，n=12）。25 只眼（75.8%）诊断为 TED 无 DON，8 只眼（24.2%）有 DON。9 只眼（27.2%）处于疾病活动期，29 只眼（87.8%）有眼球突出。TED 患者与对照组的平均 logMAR 视力差异无统计学意义（P=0.189），但中央和总 CS 评分差异有统计学意义（P<0.001，Wilcoxon-Mann-Whitney 检验）。在 DON 和非 DON 眼的 CS 比较中，中央和所有周边区域的平均评分差异有统计学意义（P<0.05，Wilcoxon-Mann-Whitney 检验）。随着临床活动评分的增加，四个周边区域中有三个区域的 CS 显著降低（Spearman 相关性，P<0.05）。
通过 CS 测试，可以在 VA 正常的情况下检测到 TED 中的视觉功能受损。随着炎症的增加和 DON 的出现，周边 CS 会恶化。对中央和周边 CS 的连续监测可能有助于早期诊断 DON。
